Sewage/Well Evaluation Form

Use this form if you are selling your home or business (POS- Point of Sale)

Helpful hints for completing this form:

To avoid delays, additional revisit fees and the possibility of evaluating the wrong property, your application must include the following information and be accompanied by a check or money order for the correct fee amount. Evaluation fees are based on the age of the septic system and the last time it was inspected. Please contact the Health Department to determine the correct fee. It is helpful to have the property tax ID number ready when you call.

You must supply the following INFORMATION:

property tax number - may be obtained from your property tax bill or receipt, Township Office, or County Equalization Office

street address, county, township, section

subdivision name and lot number, if applicable

Please answer yes or no to the following: if the home has a garbage disposal, dishwasher, water softener, municipal water, municipal sewer, outside faucet is on and the water is on inside the home

number of septic systems or holding tanks, number of bedrooms, number of bathrooms if the septic/holding tank(s) has been pumped and the most recent date

any maintenance to the well or septic system (tank(s) and/or drainfield) in the past two years

our signature or signature of your representative

if this is a business complete page three

To the best of your ability supply a SITE SKETCH that shows:

the names of the nearest crossroads

location of buildings, including configuration and dimensions

measurements from the well(s) and septic system(s) to the nearest lot line